Substances & Common Names
- Acids (酸)
- Hydrochloric acid (鹽酸，除鏽劑、清潔劑)[1]
- Sulfuric acid (硫酸，汽車電池液) [2]
- Nitric acid (硝酸，肥料/工業)[3]
- Hydrofluoric acid (氫氟酸，玻璃蝕刻、金屬清潔)[4]
- Alkalis
(鹼)
- Sodium hydroxide (氫氧化鈉/苛性鈉，水管疏通劑)[5].
- Potassium
hydroxide (氫氧化鉀，烤箱清潔劑)[6].
- Calcium hydroxide (氫氧化鈣，石灰) [7].
- Ammonia
(氨水，清潔劑/工業) [8].
- Sodium hypochlorite (次氯酸鈉，家用漂白水 3–6%) [9].
Involving Systems
- 主要影響：GI tract、airway、eyes、skin [1], [5], [9]
- 酸 → coagulative necrosis，表層壞死較多，但也可穿孔 [1]
- 鹼 →
liquefactive necrosis，深層滲透壞死 → 食管灼傷更嚴重 [10].
Presentation
- 共同表現：
- 咽喉痛、流涎、吞嚥困難、嘔吐、胸/腹痛 [1]
- 嚴重 → 上消化道出血、穿孔、縱隔炎、呼吸困難 [1]
- 酸特徵 (尤其 HF)：
- 胃為主要損傷部位 [1]
- HF：低血鈣、心律不整、QT 延長 [4]
- 鹼特徵：
- 深入食管 → 高風險穿孔、狹窄 [6]
- 常見氣道水腫、聲音沙啞、呼吸窘迫 [6]
Antidote
- 一般酸/鹼：無特效解毒劑[6]
- HF 特例：Calcium gluconate (IV 或 topical gel) [4]
Disposition / Management [1, 4, 6]
- Immediate
- Airway
first：出現聲音沙啞、喘鳴、流涎 → 早期插管
- 禁止催吐、洗胃、活性碳
- 可給予牛奶/水少量稀釋 (非強制)
- Evaluation
- 12–24 小時內胃鏡檢查 (避免 >48 小時)
- 影像檢查 (CT) 若懷疑穿孔
- Treatment
- Supportive
care, IV fluids, pain control
- 類固醇：具爭議，可能降低食管狹窄，但感染風險 ↑
- 外科手術：穿孔、廣泛壞死時
- Long-term
- 食管狹窄 (最常見後遺症)
- 增加食管癌風險 (特別是鹼灼傷)
References
- [1].Yu CH, Su YJ, Lai YC. Fatal Zargar grade 3b corrosive
injury after hydrochloric acid ingestion: A case report. Medicine
(Baltimore). 2024 Oct 4;103(40):e40017. doi: 10.1097/MD.0000000000040017.
PMID: 39465708; PMCID: PMC11460919.
- [2]. Mastrodicasa E. Sulfuric Acid Ingestion: May the
Severity of the Metabolic Acidosis be Considered as a Predictive Sign of
Late Damage to the Gastrointestinal Tract? Eur J Case Rep Intern Med.
2024 Apr 9;11(5):004437. doi: 10.12890/2024_004437. PMID: 38715891; PMCID:
PMC11073603.
- [3]. Colalillo JM, Skinner K. Why so blue?
A novel presentation of methaemoglobinaemia secondary to an inhaled
occupational nitric acid exposure. Clin Toxicol (Phila). 2025
Feb;63(2):145-147. doi: 10.1080/15563650.2024.2440547. Epub 2024 Dec 18.
PMID: 39692141.
- [4].Su YJ, Lu LH, Choi WM, Chang KS.
Survival after a massive hydrofluoric acid ingestion with ECG changes. Am
J Emerg Med. 2001 Sep;19(5):458-60. doi: 10.1053/ajem.2001.24503.
Erratum in: Am J Emerg Med. 2009 Jan;27(1):126. PMID: 11555812.
- [5].Barnes SS, Wong W Jr, Affeldt JC. A
case of severe airbag related ocular alkali injury. Hawaii J Med Public
Health. 2012 Aug;71(8):229-31. PMID: 22900239; PMCID: PMC3419824.
- [6].Chibishev A, Pereska Z, Chibisheva V,
Simonovska N. Corrosive poisonings in adults. Mater Sociomed.
2012;24(2):125-30. doi: 10.5455/msm.2012.24.125-130. PMID: 23678319;
PMCID: PMC3633385.
- [7].Schmidt SM, Schmidt CJ, Adler M,
Rahmani B. Corneal injury due to a calcium hydroxide containing food
preparation product ("cal"). Pediatr Emerg Care. 2008
Jul;24(7):468-70. doi: 10.1097/PEC.0b013e31817de2d3. PMID: 18633308.
- [8].Czerwiec A, Chevallier C, Grenet G,
Patat AM, de Souza S, Lichtfouse J; French Poison Centres Research Group;
Boucher A, Paret N; List of French Poison Centres (Centre antipoison).
Exposure to ammonia solution due to substance use: a retrospective study from
the French poison centres database (2009-2018). Clin Toxicol (Phila).
2024 Feb;62(2):107-111. doi: 10.1080/15563650.2024.2313088. Epub 2024 Feb
28. PMID: 38416057.
- [9].Patterson J, Vallance V. Severe
chemical pneumonitis following exposure to household bleach. BMJ Case
Rep. 2025 Mar 27;18(3):e262924. doi: 10.1136/bcr-2024-262924. PMID:
40147947.
- [10].Boonekamp C, Voruz F, Fehlmann C.
Accidental aspiration of a solid tablet of sodium hydroxide. BMJ Case
Rep. 2018 Jun 21;2018:bcr2018224213. doi: 10.1136/bcr-2018-224213.
Erratum in: BMJ Case Rep. 2018 Aug 17;2018:bcr-2018-224213corr1. doi:
10.1136/bcr-2018-224213corr1. PMID: 29930183; PMCID: PMC6020962.
Edited by Yu-Jang Su Aug 21, 2025
